Fertility treatments get short shrift in many insurance plans

Wednesday

Mar 6, 2013 at 10:15 AM

By Tom WilemonThe Tennessean

NASHVILLE, Tenn. — Jessica Myers’ reproductive rights got left out of the Affordable Care Act.She didn’t want an abortion. She wanted to conceive.Debates about contraception mandates and abortion coverage overshadowed any discussion of fertility treatments when Congress passed the new health law. Even though infertility affects 7.4 percent of married couples, according to the U.S. Centers for Disease Control and Prevention, few talk openly about it, let alone make public demands for better access to care.Besides the embarrassment of talking about a private matter, couples don’t want to expose themselves to callous remarks that range from jokes about making babies to advice on adopting.“I grew up my whole life with these plans to be a mom,” said Myers, who started a support group here for couples struggling with infertility. “You do everything right. You go to school. You get a job. Then the next step is ‘OK, now we get to have kids.’ You get to that point. Then you’re stopped in your tracks.” She has no idea how much she and her husband have spent on fertility treatments — “I don’t think I want to know,” Myers said. All her insurance would cover was diagnostic testing.Only a handful of states — Connecticut, Illinois, Maryland, Massachusetts, New Jersey and Rhode Island — mandate that health plans pay for fertility treatments, said Barbara Collura, president of RESOLVE: The National Infertility Association.“The bottom line is we feel when there’s conversation in the public about reproductive health, infertility is almost never discussed,” Collura said.Fertility treatments can cost several thousand dollars. Some employers do offer coverage, said Communications Vice President Susan Pisano of America’s Health Insurance Plans, the industry’s trade association. But most can’t afford to.“I know that there is probably a fairly long list of worthy services that many employers would love to be able to afford to provide for their employees and can’t,” Pisano said. “Some of these employers at this point are trying to make a decision about whether they can continue to provide coverage at all.” With fertility treatments not mandated in the federal health law, RESOLVE used a back-door approach to try to gain benefits for couples. It pushed for states to add fertility treatments as an “essential health benefit” when states weighed what their insurance exchanges would cover under the health law.The organization wound up fighting to keep one state from dropping coverage. Maryland came close to removing its existing benefit for in vitro fertilization, or IVF — an expensive process in which a woman’s egg is removed from her ovary, fertilized with sperm in a laboratory and then placed back in her womb.“We found out that behind closed doors this one committee made an exception for the IVF mandate and said that plans can choose to opt out of that,” Collura said.Maryland backpedaled after RESOLVE pressed the points that the exception was discriminatory against women and no substitute treatment for IVF exists, Collura said.

A federal decisionOne woman spoke up for infertility coverage at a public hearing in the fall here on essential health benefits proposed for Tennessee, but Gov. Bill Haslam ultimately decided not to specify what benefits would be covered. Because the federal law does not mandate fertility treatments as it does contraception coverage, Tennessee couples trying to have babies will have to pay out of pocket for fertility treatments in most cases.Dr. George A. Hill, founder of Nashville Fertility Center, said he wasn’t surprised by the federal law’s omission.“It’s almost looked at by insurance companies like plastic surgery — that it’s elective, that you choose to do that,” Hill said. “A lot of these patients don’t have a choice. It’s their only option.” Nashville Fertility Center offers IVF treatment at a flat rate of $8,800 for couples without insurance coverage, but it charges more if additional procedures are required. Nationwide, IVF typically is $12,000 to $15,000, Collura said.However, she noted that less than 5 percent of couples trying to conceive actually need in vitro fertilization.A less expensive procedure, costing around $1,000 or less, is intrauterine insemination — a process in which sperm are medically inserted into the uterus. But in the long run, that procedure can wind up costing more because it increases the likelihood of quadruplets and larger multiple births more than IVF treatments, Collura said.Couples aren’t the only people seeking fertility treatments. So are single people. Female cancer patients may want to freeze and preserve their eggs before undergoing oncology treatments while male cancer patients may want to do the same with sperm.“There is no question that’s appropriate medical therapy in a young, reproductive-age person, whether it is male or female,” Hill said.Busy professional women who want to delay having families are also freezing their eggs.Women returning from Iraq and Afghanistan with war injuries can need fertility treatments. The U.S. Senate approved legislation in December that would cover fertility treatments and reimbursements for up to three adoptions as long as the cost did not exceed one in vitro fertilization cycle. That bill died when Congress adjourned, but new legislation has been introduced in both the House and Senate.Myers and her husband tried intrauterine insemination. It didn’t work.“We got to that point where in vitro was the next step for us,” she said. “We had to take into consideration the financial aspect. We knew that financially we could pursue in vitro or we could pursue adoption, but we couldn’t do both. For us, after a lot of consideration and soul searching, we decided to not pursue in vitro.” Last year they started the adoption process, doing the paperwork and undergoing the education required in Tennessee for a domestic adoption. They have no idea whether or when they will be able to adopt.“Adoption is not something to go into lightly,” Myers said. “Adoption is a different way to build a family.” Couples should have the right to choose the way they want to make a family because it’s simply not right for people who have the disease of infertility to be expected to solve a societal problem, Collura said.“You look at people who ’come out of the closet’ about their infertility and they get completely slammed by the public,” she said. “They’re told, ‘Our world is overpopulated. Just adopt — you’re being selfish.’ ”

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